Elite Medical Center LLC
Organization Active NPI Physical Medicine & Rehabilitation Physician · Lyman, SC
NPI 1730727009 · NPPES record last updated Dec 11, 2024
Key facts
- NPI
- 1730727009
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physical Medicine & Rehabilitation Physician 208100000X
- Legal business name
- ELITE MEDICAL CENTER LLC
- Practice address
- 12 Groce Rd
Lyman, SC 29365-1631 - Phone
- (864) 439-1345
- Fax
- (864) 439-1346
- NPI assigned
- Dec 17, 2019
- Organization subpart
- No
Authorized official
- Name
- Dr. Kevin Prime, DC
- Title
- Owner
- Phone
- (704) 473-4653
Practitioners 5
-
Kevin Prime, DC
-
Syreeta Dendy, NP-C
-
Jay A Whitlock, D.C.
-
Steven K Barnett, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230915003452 | SC | Part B Supplier - Clinic/Group Practice | 6103256284 |
Receives reassigned benefits from 3 practitioners Practice locations: Lyman, SC |
National Provider Directory
Interoperability endpoints
- https://api.platform.athenahealth.com/17366/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Medicine & Rehabilitation Physician |
208100000X | Yes | ||
| General Practice Physician |
208D00000X |
Addresses
Primary practice location
12 Groce Rd
Lyman, SC 29365-1631
Mailing address
12 Groce Rd
Lyman, SC 29365-1631
Phone (864) 439-1345
Other names
- Elite Medical Center
Other providers in Lyman, SC
- Elizabeth Deal
- Dialysis Newco LLC
- Julie Lynn Dillon
- DLB Construction
- Latoya Downs
- Elite Wellness Center LLC
- Excel Nursing, LLC
- Fig Tree Medical
- J. Mereinda Fisher
- Shannon Fleming
All providers in Lyman, SC · Physical Medicine & Rehabilitation Physician in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 11, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.